Type 2 diabetes in Indigenous and non-Indigenous children and adolescents in New South Wales

OBJECTIVE: To determine the incidence of type 2 diabetes mellitus (T2DM) in 2001-2006 in young people < 19 years and the characteristics of T2DM in the Indigenous group. DESIGN AND SETTING: Prospective population-based incidence study, New South Wales. PARTICIPANTS: Primary ascertainment was from the Australasian Paediatric Endocrine Group NSW Diabetes Register, with secondary ascertainment from the National Diabetes Register (Australian Institute of Health and Welfare). MAIN OUTCOME MEASURES: Incidence of T2DM in young people in NSW; incidence of T1DM and T2DM in Indigenous young people; characteristics at diagnosis. RESULTS: There were 128 incident cases of T2DM (62 boys, 66 girls) in the study period. The median age at diagnosis was 14.5 years (interquartile range, 13.0-16.4), and 90% were overweight or obese (body mass index > 85th percentile for age). Mean annual incidence was 2.5/100,000 person-years (95% CI, 2.1-3.0) in 10-18-year-olds. Of the ethnic groups represented, white Australian comprised 29%, Indigenous 22%, Asian 22%, North African/Middle Eastern 12% and Māori/Polynesian/Melanesian 10%. The incidence of T2DM was significantly higher in the Indigenous than the non-Indigenous group (incidence rate ratio, 6.1; 95% CI, 3.9-9.7; P<0.001), but incidence rates of T1DM were similar (15.5 v 21.4/100,000, respectively). CONCLUSIONS: T2DM accounts for 11% of incident cases of diabetes in 10-18-year-olds, and the majority are overweight or obese. The high rate among Indigenous Australian children supports screening for T2DM in this population.     

A nine-year prospective study on the incidence of childhood type 1 diabetes mellitus in China

ＩＮＴＲＯＤＵＣＴＩＯＮＴｙｐｅ1ｄｉａｂｅｔｅｓｍｅｌｌｉｔｕｓ(ＤＭ),ｏｎｅｏｆｔｈｅｍｏｓｔｃｏｍｍｏｎｃｈｉｌｄｈｏｏｄｃｈｒｏｎｉｃｄｉｓｅａｓｅｓ,ｈａｓｗｉｔｎｅｓｓｅｄａｎｉｎｃｒｅａｓｉｎｇｉｎｃｉｄｅｎｃｅｉｎｔｈｅｗｏｒｌｄ(ＢｕｒｄｅｎａｎｄＨｅａｒｎｓｈａｗ,1989;Ｐｏｚｚｉｌｌｉ,1998).Ｉｔｉｓｉｍｐｏｒｔａｎｔｔｏｃｈａｒａｃｔｅｒｉｚｅｉｔｓｅｐｉｄｅｍｉｏｌｏｇｙｆｏｒｓｅｖｅｒａｌｒｅａｓｏｎｓ.Ｆｉｒｓｔ,ｓｕｒｖｅｉｌｌａｎｃｅｄａｔａｃａｎｂｅｕｓｅｄｔｏｈｙｐ…     

武汉市儿童胰岛素依赖型糖尿病发病率调查

根据WHO DIAMOND计划,采用“捕获—再捕获”方法.对1989～ 1996年武汉市区 0～14岁儿童胰岛素依赖型糖尿病发病率进行了流行病学双向性前瞻调查。结果表明,其平均年发病率为0.4672/10万/年（男性 0.4526/10 万/年、女性 0.4828/10万/年）,按年龄构成际化后的标化率为 0.4798/10万/年（男性0.4621/10万/年、女性O.4988/10万/年）;男女性发病率比约为0.94。年度发病率呈现波动,1990和1993年最低（0.2492/10万）,1995年最高(0.8721/10万）。两个来源共同登记的确定水平为90.90％,预计年发病率为 0.4983/10万（95％CI=0.4441/10万～0.5526/10 万）。同其他国家和地区相比,武汉市儿童胰岛素依赖型糖尿病发病率较低。     

Trends in licit opioid use in Australia, 1984-1998: comparative analysis of international and jurisdictional data

OBJECTIVES: To examine trends from 1984 to 1998 in licit opioids used in Australia compared with nine other developed countries, and in New South Wales compared with other Australian jurisdictions. DESIGN: Poisson regression analysis of annual rates of national and jurisdictional consumption of methadone, morphine and pethidine. MAIN OUTCOME MEASURES: All drug data were standardised to defined daily doses per 1000 population per day. RESULTS: Methadone consumption increased by, on average, 12% per year (RR, 1.12; 95% CI, 1.08-1.17), with Australia in the first rank of countries. Morphine use increased by 5% per year (RR, 1.05; 95% CI, 1.02-1.09), with Australia ranking equal second with three other countries behind Denmark. Consumption of pethidine in all 10 countries was unchanged (RR, 0.99; 95% CI, 0.97-1.00), with Australia equal first. In Australia, use of methadone syrup increased by 17% per year (RR, 1.17; 95% CI, 1.16-1.17) and by 11% per year for methadone tablets (RR, 1.11; 95% CI, 1.10-1.12). Consumption of methadone syrup in NSW was more than double that of any other jurisdiction. Consumption of methadone tablets was 2.4 times higher in South Australia (RR, 2.35; 95% CI, 2.09-2.65) than NSW. The Northern Territory, Tasmania and Queensland also had significantly higher consumption than NSW. From 1991 to 1998, controlled-release morphine consumption increased by 27% per year nationally (RR, 1.27; 95% CI, 1.24-1.30). The NT had 2.6 times more supply of morphine (RR, 2.63; 95% CI, 1.71-4.03) and Tasmania 58% more supply than NSW (RR, 1.58; 95% CI, 1.11-2.25). CONCLUSIONS: Australia's consumption of licit opioids ranked high internationally. There were diverse trends in the supply of licit opioids to Australia's jurisdictions, resulting in a heterogeneous pattern throughout the country.     

The Threats to Australian Patient Safety (TAPS) study: incidence of reported errors in general practice

OBJECTIVE: To determine the incidence of errors anonymously reported by general practitioners in NSW. DESIGN: The Threats to Australian Patient Safety (TAPS) study used anonymous reporting of errors by GPs via a secure web-based questionnaire for 12 months from October 2003. SETTING: General practices in NSW from three groupings: major urban centres (RRMA 1), large regional areas (RRMA 2-3), and rural and remote areas (RRMA 4-7). PARTICIPANTS: 84 GPs from a stratified random sample of the population of 4666 NSW GPs - 41 (49%) from RRMA 1, 22 (26%) from RRMA 2-3, and 21 (25%) from RRMA 4-7. Participants were representative of the GP source population of 4666 doctors in NSW (Medicare items billed, participant age and sex). MAIN OUTCOME MEASURES: Total number of error reports and incidence of reported errors per Medicare patient encounter item and per patient seen per year. RESULTS: 84 GPs submitted 418 error reports, claimed 490 864 Medicare patient encounter items, and saw 166 569 individual patients over 12 months. The incidence of reported error per Medicare patient encounter item per year was 0.078% (95% CI, 0.076%-0.080%). The incidence of reported errors per patient seen per year was 0.240% (95% CI, 0.235%-0.245%). No significant difference was seen in error reporting frequency between RRMA groupings. CONCLUSIONS: This is the first study describing the incidence of GP-reported errors in a representative sample. When an anonymous reporting system is provided, about one error is reported for every 1000 Medicare items related to patient encounters billed, and about two errors are reported for every 1000 individual patients seen by a GP.     

Prevalence of Huntington disease in New South Wales in 1996

OBJECTIVE: To estimate the prevalence of Huntington disease (HD) in New South Wales on Australian Census Day (6 August) 1996. DESIGN: Survey of records of the Huntington Disease Service and major hospitals, and of neurologists, psychiatrists, clinical geneticists and genetic counsellors. SUBJECTS AND SETTING: All patients in NSW who, on Census Day 1996, either had a definite diagnosis of HD (motor signs of chorea or ataxia and family history of HD or positive DNA test result) or would have had signs and later received a definite diagnosis (assessed 1 April 1997 to 1 July 1999). MAIN OUTCOME MEASURES: Prevalence (HD patients per 100,000 population); patient characteristics; year and basis of diagnosis. RESULTS: 380 patients with definite HD were identified, giving a prevalence of HD in NSW in 1996 of 6.29 per 100,000 population (95% CI, 5.68-6.96). A third of HD patients were aged 60 years or older. Diagnosis was confirmed by DNA testing for 171 patients (45%), including 30 (8%) with no recorded family history. Average numbers of new diagnoses per year were 11.8 (1984-1988), 21.8 (1989-1993) and 28.6 (1994-1998). Estimated number of people with a 50% risk of inheriting the HD mutation was 25.2 per 100,000 population. Estimated incidence of HD in 1996 was 0.65 per 100,000 population. CONCLUSIONS: Prevalence of HD in NSW is similar to estimated prevalence in other Australian and Western populations. Increasing numbers of cases are being diagnosed, and the 18 chronic care beds currently designated for HD patients in NSW are unlikely to be sufficient.     

Ten-year incidence of diabetes in older Australians: the Blue Mountains Eye Study

OBJECTIVE: To estimate the incidence of diabetes and impaired fasting glucose (IFG), and increased risk associated with the metabolic syndrome, in a representative population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 + years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999 and 1952 (75.6% of survivors) during 2002-2004; 2123 participants with normal blood glucose levels at baseline were considered at risk of developing incident diabetes. Main outcome measures: Incident diabetes (or IFG) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level >or= 7.0 mmol/L (or 5.6-6.9 mmol/L). Kaplan-Meier cumulative 10-year incidence was calculated. RESULTS: The overall 10-year incidence of diabetes and IFG was 9.3% and 15.8%, respectively. Participants with metabolic syndrome at baseline had a higher risk of incident diabetes than those without metabolic syndrome (29.2% v 8.6%). Baseline factors associated with incident diabetes were elevated fasting glucose level (adjusted odds ratio [OR], 4.5; 95% CI, 3.4-6.1 per mmol/L), obesity (OR, 2.0; 95% CI, 1.3-2.8), diabetes family history (OR, 1.7; 95% CI, 1.2-2.5), current smoking (OR, 1.6; 95% CI, 1.0-2.7) and high density lipoprotein cholesterol level < 1.0 mmol/L (OR, 2.4; 95% CI, 1.5-3.8). Similar baseline factors were associated with incident IFG. CONCLUSION: This population-based study provides data on the incidence of diabetes and IFG in an older, predominantly white population, and confirms that metabolic and lifestyle factors are major risk factors for diabetes.     

Incidence of autism spectrum disorders in children in two Australian states

AIM: To ascertain the incidence of autism spectrum disorders in Australian children. SETTING: New South Wales (NSW) and Western Australia (WA), July 1999 to December 2000. DESIGN: Data were obtained for WA from a prospective register and for NSW by active surveillance. MAIN OUTCOME MEASURES: Newly recognised cases of autism spectrum disorders (defined as autistic disorder, Asperger disorder and pervasive developmental disorder not otherwise specified [PDD-NOS]) in children aged 0-14 years; incidence was estimated in 5-year age bands (0-4 years, 5-9 years, 10-14 years). RESULTS: In WA, 252 children aged 0-14 years were identified with autism spectrum disorder (169 with autistic disorder and 83 with Asperger disorder or PDD-NOS). Comparable figures in NSW were 532, 400 and 132, respectively. Most children were recognised with autistic disorder before school age (median age, 4 years in WA and 3 years in NSW). Incidence of autistic disorder in the 0-4-years age group was 5.5 per 10,000 in WA (95% CI, 4.5-6.7) and 4.3 per 10,000 in NSW (95% CI, 3.8-4.8). Incidence was lower in older age groups. The ratio of all autism spectrum disorders to autistic disorder alone was 1.5:1 in WA and 1.3:1 in NSW, and rose with age (1.8:1 and 2.9:1 in 10-14-year-olds in WA and NSW, respectively). CONCLUSIONS: These are the first reported incidence rates for autism for a large Australian population and are similar to rates reported from the United Kingdom. Ongoing information gathering in WA and repeat active surveillance in NSW will help to monitor any future changes.     

Epidemiology of Diabetes in Adults Aged 35 and Older from Shanghai,China

Objective This study aimed to investigate the epidemiology of diabetes in adults from Shanghai, aged 35 and older, in 2013.
Methods We estimated the diabetes prevalence in a representative sample of 18,736 adults who were selected through a multistage stratified cluster sampling process. A standard questionnaire containing questions about demographic characteristics and lifestyle factors was distributed. After an overnight fast of at least 10 hours, a venous blood sample was collected from each participant. For each patient without a history of diabetes, another blood sample was drawn 120 min after an oral glucose tolerance test to identify undiagnosed diabetes and prediabetic condition.
Results Among Shanghai residents aged 35 and above, the overall weighted prevalence of diabetes was 17.6%[95%confidence interval (CI):16.4%-18.8%]. The prevalences were 19.3%in men and 15.8%in women as well as 19.1%, 15.4%, and 16.1%in urban, suburban, and rural residents, respectively. In addition, the weighted prevalence of prediabetes was 16.5% (95% CI: 15.3%-17.8%), with the prevalences of 16.5%in men, 16.6%in women, 15.2%in urban residents, 18.0%in suburban residents, and 18.5% in rural residents. Among all patients with diabetes, 68.1% (95% CI: 64.3%-71.6%) were aware of their status, 63.5%(95%CI:60.0%-66.9%) received diabetes treatment, but only 35.1%(95%CI:32.4%-37.8%) had adequate glycemic control.
Conclusion In Shanghai, diabetes and prediabetes are highly prevalent. However, 1/3rd of diabetes cases are undiagnosed, and the rate of glycemic control is low.     

End-stage renal disease in aboriginals in New South Wales: a very different picture to the Northern Territory

OBJECTIVES: To compare the incidence of end-stage renal disease (ESRD) among Aboriginals in New South Wales with the incidence among Aboriginals in the Northern Territory, and to compare the patterns of ESRD among Aboriginals and non-Aboriginals in NSW. DESIGN: Secondary data analysis of information from unpublished and published Australia and New Zealand Dialysis and Transplant Registry reports. MAIN OUTCOME MEASURES: Average annual incidence of ESRD (persons per million); form of renal replacement therapy; mortality at 31 March 1998; patient and graft survival one and five years after transplant. RESULTS: Each year in NSW, 5-17 new Aboriginal patients are treated for ESRD. There was no increase in the average annual incidence of ESRD among NSW Aboriginals (118 per million in 1988-1989 and 111 per million in 1996-1997), whereas incidence in the NT increased from 255 per million to 800 per million. In NSW, ESRD was attributed to diabetes in 32% of Aboriginal patients, compared with 13% of non-Aboriginal patients (P < 0.001). In NSW, Aboriginal patients were younger and more likely to be female, a pattern similar to that in the NT. The outcome of ESRD treatment is not significantly different between Aboriginals and non-Aboriginals in NSW. CONCLUSION: There is a different pattern of incidence of ESRD and of outcomes with treatment among Aboriginals in NSW compared with those in the NT. A possible explanation is that the lower incidence in NSW reflects less profound socioeconomic disadvantage and better access to primary and specialist care.     

Incidence of hip fracture in New South Wales: are our efforts having an effect?

OBJECTIVE: To examine trends in hospital admission for hip fracture in New South Wales between July 1990 and June 2000. DESIGN: Analysis of routinely collected hospital separation data. SETTING: Public and private acute-care hospitals in NSW. PARTICIPANTS: Admissions of patients aged 50 years and over with a primary diagnosis of fracture of the neck of femur (International classification of diseases, 9th revision [ICD-9] code 820 or ICD-10 codes S72.0-S72.2). MAIN OUTCOME MEASURES: Number and rates of hospital admission for fracture of the neck of femur per 1000 population; inpatient mortality rates per 1000 admissions. RESULTS: Between July 1990 and June 2000, the number of admissions to NSW acute-care hospitals for hip fracture increased by 41.9% in men (from 1059 to 1503 per year) and by 31.2% in women (from 3160 to 4145 per year). However, age-specific and age-adjusted rates remained practically unchanged. The average length of stay for admissions for hip fracture decreased significantly from 19.2 days (95% CI, 18.5-19.8 days) in 1990-1991 to 14.2 days (95% CI, 13.8-14.6 days) in 1999-2000. No significant change was observed in the overall inpatient death rates per 1000 admissions. CONCLUSIONS: The findings support recent reports that the increase in hip fracture rates during most of the past century may have ended. However, the number of admissions for hip fracture is still rising. Preventive measures to reduce the burden of this condition on the healthcare system and community need to be pursued and strengthened.     

Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus.

CONTEXT: Although oligomenorrhea has been associated cross-sectionally with insulin resistance and glucose intolerance, it is not known whether oligomenorrhea is a marker for increased future risk of type 2 diabetes mellitus (DM). OBJECTIVE: To prospectively assess risk of type 2 DM in women with a history of long or highly irregular menstrual cycles. DESIGN AND SETTING: The Nurses' Health Study II, a prospective observational cohort study. PARTICIPANTS: A total of 101 073 women who had no prior history of DM and who reported their usual menstrual cycle pattern at age 18 to 22 years on the baseline (1989) questionnaire. MAIN OUTCOME MEASURE: Incident reports of DM, with follow-up through 1997, compared among women categorized by menstrual cycle length (5 categories). RESULTS: During 564 333 person-years of follow-up, there were 507 cases of type 2 DM. Compared with women with a usual cycle length of 26 to 31 days (referent category) at age 18 to 22 years, the relative risk (RR) of type 2 DM among women with a menstrual cycle length that was 40 days or more or was too irregular to estimate was 2.08 (95% confidence interval [CI], 1.62-2.66), adjusting for body mass index at age 18 years and several other potential confounding variables. The RR of type 2 DM associated with long or highly irregular menstrual cycles was greater in obese women, but was also increased in nonobese women (at body mass indexes at age 18 years of <25, 25-29, and >/=30 kg/m, RRs were 1.67 [95% CI, 1.14-2.45], 1.74 [95% CI, 1.07-2.82], and 3.86 [95% CI, 2.33-6.38], respectively). CONCLUSION: Women with long or highly irregular menstrual cycles have a significantly increased risk for developing type 2 DM that is not completely explained by obesity.     

血浆网膜素1 与2 型糖尿病周围神经病变 及其严重程度关系的研究

目的 研究2 型糖尿病（T2DM）患者血浆网膜素1（Omentin-1）水平与糖尿病周围神经病变（DPN） 及其严重程度的关系。方法 选取2017 年3 月-2017 年9 符合入选标准的T2DM 患者122 例,分为单纯 T2DM 患者67 例（对照组）和合并DPN 患者55 例（DPN 组）。收集患者临床资料,采用Logisitc 回归模型 分析DPN 的危险因素,作受试者工作特征（ROC）曲线探索Omentin-1 诊断DPN 的效率,并应用线性回归 分析Omentin-1 与评估DPN 严重程度的多伦多临床评分系统（TCSS）评分间关系。结果 ① DPN 组患者 Omentin-1 水平低于对照组（P <0.05）;Omentin-1 与胰岛素抵抗系数（HOMA-IR）（r =-0.375,P =0.000） 及糖化血红蛋白（HbAlc）（r =-0.445,P =0.000）呈负相关。②多因素Logistic 回归示：HbAlc[O^R=4.003（95%CI： 1.016,10.776）] 和HOMA-IR[（O^R=4.595（95%CI ：1.709,12.324）] 为DPN 的危险因素;而Omentin-1 [O^R=0.257（95%CI ：0.112,0.589）] 为DPN 的保护因素。③ ROC 曲线示Omenitn-1 诊断DPN 的曲线 下面积为0.713（95%CI ：0.622,0.804）,且当Omentin-1 切值取18.8 ng/ml 时,其诊断效率最高,敏感性为 69.7%,特异性为71.8%。④ Omentin-1 与TCSS 评分负相关（r =-0.606,P =0.000）。结论 Omentin-1 是 DPN 的保护因素,在T2DM 患者中可辅助DPN 诊断及其严重程度的评估。     

Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

OBJECTIVES: To audit glycaemic control and incidence of severe hypoglycaemia in children and adolescents with type 1 diabetes in New South Wales (NSW) and the Australian Capital Territory (ACT). DESIGN: A multicentre, population-based, cross-sectional study from 1 September to 31 December, 1999. PARTICIPANTS: 1190 children and adolescents aged 1.2-15.8 years with type 1 diabetes, identified from three hospital-based paediatric diabetes units, four private city-based paediatric practices and 18 regional outreach clinics in NSW and the ACT. MAIN OUTCOME MEASURES: HbA(1c) level and incidence of severe hypoglycaemia (defined by unconsciousness or seizures). RESULTS: The response rate was 67% (1190 of a target group of 1765). The median HbA(1c) level was 8.2% (interquartile range, 7.6%-9.1%). Significant predictors of HbA1c level in a multiple regression model were duration (b = 0.05; 95% CI, 0.02-0.07) and insulin dose/kg (b = 0.46; 95% CI, 0.27-0.66). At least one episode of severe hypoglycaemia in the previous three months was reported in 6.7%, and the rate of severe hypoglycaemia was 36/100 patient-years. Significant predictors of hypoglycaemia in a Poisson regression model were younger age (P = 0.03), male sex (P = 0.04), longer diabetes duration (P = 0.02), and > 3 daily insulin injections (P = 0.02), but not HbA(1c) level. Children with diabetes had higher BMI standard deviation scores compared with population standards, and those in the highest quartile of BMI standard deviation score were younger, had shorter diabetes duration and had higher HbA(1c) level. CONCLUSIONS: Many children and adolescents with type 1 diabetes have suboptimal glycaemic control, placing them at high risk of developing microvascular complications. Those with longer diabetes duration are at increased risk of suboptimal glycaemic control and severe hypoglycaemia and should be targeted for interventional strategies.     

Highly active antiretroviral therapy per se decreased mortality and morbidity of advanced human immunodeficiency virus disease in Hong Kong

Background Morbidity and mortality of advanced human immunodeficiency virus infection (HIV) have declined in Western industrialized countries since the availability of highly active antiretroviral therapy (HAART). It is unclear if this has also happened in Hong Kong.Methods We studied a retrospective cohort of patients with advanced HIV disease in Hong Kong, China. First, the mortality of advanced HIV disease per year was calculated for the decade 1993 to 2002, both annually and according to patient observation before and after 1997. Second, the event rates were estimated for the clinical end points of acquired immune deficiency syndrome (AIDS) and death. Univariate and multivariate analyses were then performed to identify associated factors. Results The crude mortality of advanced HIV disease declined from 10.8-30.4 per 100 patients during 1993-1996, to 0.8-6.9 per 100 patients during 1997-2002. A rate ratio of 4.04 (95% CI, 2.52-6.47) was evident for those observed in 1993-1996, compared to those in 1997-2002. In a multivariate analysis where calendar period was adjusted, use of highly active antiretroviral therapy was associated with rate ratios of 0.13 (95% CI, 0.05-0.33) for death after AIDS, 0.08 (95% CI, 0.04-0.19) for AIDS after a CD4 cell count &lt;200/μl, and 0.21 (95% CI, 0.07-0.67) for death after CD4 cell count &lt;200/μl. In the same analysis, calendar period ceased to be a significant factor after adjustment for use of HAART.Conclusions The mortality and morbidity of advanced human immunodeficiency virus disease have declined in Hong Kong. This improved prognosis was attributable to the use of highly active antiretroviral therapy.     

老年高血压人群发生糖代谢异常风险的10年队列研究

目的 观察老年高血压(HT)及非高血压(NHT)人群糖代谢异常的发生情况及其危险因素.方法 采用前瞻性队列研究方法,研究对象为1999至2009年在解放军总医院体检的60岁以上老年人,除外基线时已确诊2型糖尿病(T2DM)及糖调节受损(IGR)者.观察在10年中发生DM及IGR的情况及影响因素,应用COX风险比例模型分析相关危险因素,Kaplan-Meier法分析累计发病率.结果 (1) 1999年调查人数为1 136人,纳入糖耐量正常582人,其中HT组384例,NHT组198人.随访10年后,HT组发生T2DM显著高于NHT组(27.6％比18.7％,P＜0.05),HR( 95％ CI)为1.48(1.07～2.04);两组DM发病密度分别为33.8‰和20.6‰.HT组与NHT组的IGR发生率差异无统计学意义(P＞0.05);新发HT组与NHT组相比,DM及IGR的发生率差异无统计学意义(P＞0.05).(2)血脂紊乱及HT是发生T2DM的独立危险因素,HR(95％CI)分别为1.459(1.027～2.072)及1.516(1.039～2.212);同时也是发生糖代谢异常的独立危险因素,HR (95％ CI)分别为1.545(1.087～2.195)及1.524(1.044 ～2.224);HT与NHT人群T2DM及糖代谢异常的累积发生率差异均有统计学意义(均P ＜0.05).结论 老年人群合并HT后其糖尿病风险增加,是非NHT人群的1.52倍.血脂紊乱也是T2DM及糖代谢异常的独立危险因素.     

An ambulatory stabilisation program for children with newly diagnosed type 1 diabetes

OBJECTIVES: (i) To evaluate the benefits and adverse effects of a Diabetes Day Care Program (DDCP); and (ii) to compare outcomes in two cohorts diagnosed before and after implementing the DDCP ("pre-DDCP" and "post-DDCP"). DESIGN: Outcomes from the pre-DDCP cohort were compared with those of the post-DDCP cohort. SETTING: The study was conducted from March 2001 to October 2002 at the Children's Hospital at Westmead. PARTICIPANTS: The pre-DDCP cohort comprised all children newly diagnosed with type 1 diabetes from March 2000 to November 2000 (n = 49). The post-DDCP cohort were those diagnosed from November 2000 to August 2001 (n = 61). MAIN OUTCOME MEASURES: Length of stay, adverse events, insulin requirement and glycohaemoglobin (HbA(1c)) level over the first year after diagnosis were ascertained from medical records. Questionnaires to measure parents' knowledge of diabetes, emotional adjustment to diabetes, and responsibility for and conflict over specific diabetes management tasks were completed by parents at 6-monthly intervals. RESULTS: Median length of hospital stay decreased from 5.14 days (range, 2-10) to 1.70 days (range, 0-10) (P < 0.001). There were no differences between the two cohorts in insulin requirement at 12 months (pre-DDCP: 0.9 U/kg [95% CI, 0.8-1.0]; post-DDCP: 0.8 U/kg [95% CI, 0.7-0.9]; P = 0.22), HbA(1c) level at 12 months (pre-DDCP: 8.4% [95% CI, 8.0%-8.9%]; post-DDCP: 8.2% [95% CI, 7.9%-8.5%]; P = 0.37) and adverse events over the first year after diagnosis. Both groups reported similar scores for the parental questionnaires. CONCLUSIONS: Ambulatory stabilisation of children with type 1 diabetes provides similar metabolic outcomes for the child, and comparable levels of diabetes knowledge and similar psychosocial outcomes for the family, to inpatient stabilisation programs.     

Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: The Hoorn Study

CONTEXT: Persons with impaired glucose tolerance (IGT) are known to have an elevated risk of developing diabetes mellitus. Less is known about diabetes risk among persons with impaired fasting glucose (IFG) or with normal glucose levels. OBJECTIVE: To determine the incidence of diabetes in relation to baseline fasting and postload glucose levels and other risk factors. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study conducted from October 1989 to February 1992 among 1342 nondiabetic white residents of Hoorn, the Netherlands, aged 50 to 75 years at baseline, in whom fasting plasma glucose (FPG) levels and glucose levels 2 hours after a 75-g oral glucose tolerance test were measured at baseline and at follow-up in 1996-1998. MAIN OUTCOME MEASURES: Cumulative incidence of diabetes, defined according to the diagnostic criteria of the World Health Organization (WHO-1985 and WHO-1999) and the American Diabetes Association (ADA-1997), during a mean follow-up of 6.4 years, compared among participants with IFG, IGT, and normal glucose levels at baseline. RESULTS: The cumulative incidence of diabetes was 6.1%, 8.3%, and 9.9% according to the WHO-1985, ADA, and WHO-1999 criteria, respectively. The cumulative incidence of diabetes (WHO-1999 criteria) for participants with both IFG and IGT was 64.5% compared with 4.5% for those with normal glucose levels at baseline. The odds ratios for diabetes (WHO-1999 criteria), adjusted for age, sex, and follow-up duration, were 10.0 (95% confidence interval [CI], 6.1-16.5), 10.9 (95% CI, 6.0-19.9), and 39.5 (95% CI, 17.0-92.1), respectively, for those having isolated IFG, isolated IGT, and both IFG and IGT. In addition to FPG and 2-hour postload glucose levels (P<.001 for both), the waist-hip ratio also was an important risk factor for developing diabetes (P =.002). CONCLUSION: In this study, the cumulative incidence of diabetes was strongly related to both IFG and IGT at baseline and, in particular, to the combined presence of IFG and IGT.     

National surveillance for type 2 diabetes mellitus in Taiwanese children

Context  Despite a disturbing trend of increasing prevalence of type 2 diabetes mellitus (DM) in childhood, little is known about the epidemiology of childhood type 2 DM, especially in the Taiwanese population. Objective  To study the rate and risk factors for childhood type 2 DM based on a nationwide screening program in Taiwan. Design, Setting, and Participants  Screening in 1999 for type 2 DM using urine and blood testing and confirmed by follow-up telephone survey among schoolchildren aged 6 to 18 years in Taiwan, followed by a nested case-control study conducted in 2002 comparing 137 children with type 2 DM with 1000 randomly selected children without diabetes chosen to represent the age and sex distribution of the whole student population. Main Outcome Measures  Rate and identification of risk factors associated with childhood type 2 DM. Results  The rate of newly identified diabetes was 9.0 per 100 000 for boys and 15.3 per 100 000 for girls. Follow-up at 3 years revealed that, of 253 children with newly diagnosed diabetes, 24 (9.5%) had type 1 DM, 137 (54.2%) had type 2 DM, and 22 (8.7%) had secondary diabetes. Compared with children aged 6 to 9 years, the odds ratios (ORs) and 95% confidence intervals (CIs) of type 2 DM increased to 6.59 (3.23-13.4) for those aged 13 to 15 years and to 4.59 (2.07-10.2) for those aged 16 to 18 years. The OR (95% CI) of type 2 DM in children with a body mass index in the 95th percentile or higher (obesity) was 18.8 (9.22-38.5) compared with those with a body mass index in less than the 50th percentile. Other factors significantly associated with type 2 DM were hypercholesterolemia (OR, 1.80; 95% CI, 1.04-3.23), blood pressure greater than the 85th percentile (OR, 1.70; 95% CI, 1.07-2.70), and positive family history of diabetes (OR, 3.95; 95% CI, 2.01-7.78). Conclusions  Our mass screening program showed that type 2 DM is the leading cause of childhood DM in Taiwan. Obesity is a major risk factor for the development of type 2 DM in children.